RADIOLOGY GUIDED ANESTHESIA PATHWAYS IN THE EMERGENCY DEPARTMENT: EFFECTS ON TIME TO PROCEDURE, ADVERSE EVENTS, AND DISPOSITION; A SYSTEMATIC REVIEW

Abstract Background: Imaging-guided regional anesthesia and sedation workflows are increasingly used in emergency departments (EDs) to improve anesthesia for painful conditions and procedures while supporting timely imaging, definitive intervention, and safe disposition. Objective: To synthesize evidence on radiology-guided anesthesia pathways in the ED (primarily ultrasound-guided regional anesthesia/nerve blocks and imaging-linked workflows) and their effects on time to procedure, adverse events, opioid requirements, and disposition-related outcomes (ED length of stay, admission patterns). Methods: A PRISMA-aligned systematic review was conducted in PubMed Central on December 28, 2025. Eligible studies were original human research conducted in ED settings evaluating imaging-guided anesthesia (ultrasound-guided nerve blocks integrated into ED care pathways), reporting at least one prespecified outcome (time metrics, adverse event, opioid use, ED and hospital LOS, disposition). Risk of bias was assessed using RoB 2 for randomized trials and the NIH observational tools for nonrandomized designs. Results: Eight eligible original studies were fully retrievable in PMC and included. In studies, ultrasound-guided blocks were consistently feasible in ED workflow and were associated with clinically meaningful pain reduction and low complication rates, with several reports supporting reduced opioid exposure and/or reduced monitoring needs. Implementation studies suggested that standardized pathways and curricula increased nerve block use and may improve throughput measures. Disposition outcomes were variably reported and heterogeneous. Conclusion: In ED care pathways, radiology-guided regional anesthesia appears safe and effective, with signals for reduced opioid use and potential operational benefits. Evidence for consistent improvements in time-to-procedure and disposition endpoints is limited by heterogeneity and variable outcome reporting. Larger pragmatic trials and pathway-level evaluations with standardized operational endpoints are needed.